Recovery from Psychosis
Recovering from an episode of psychosis can take 6 months to 2 years. It is important for people in recovery to stay motivated and committed to meaningful personal goals. Providers of treatment or support should keep in mind that the ultimate goal is not only to “reduce symptoms,” but to get the person back into school, work, or relationships they were missing out on.
Here are some added tips for helping to maintain a steady recovery:
Give Everyone Involved the Time and Space They Need to Learn.
Accepting that psychosis is an ongoing life issue is a big change for the person who experiences it and for the family. When psychosis is first recognized, everyone involved has a lot to learn. They must keep an open mind when deciding what to do next. For the person who has psychosis, the change means taking on new responsibilities for self-care (e.g., attending to sleep and exercise, participating in treatment) while at the same time relying on others (e.g., family, professionals, employers). For families, it means being available, while at the same time respecting their loved one’s rights to privacy and personal decision-making. Everyone in the family is in recovery together as they seek to find new balance.
Learn to Recognize the Symptoms
Taking care of oneself becomes easier when one can read symptoms well. This goes for everyone involved. Sometimes it is the person with early psychosis who is first to notice changes in mood or attention; other times, it is someone else. In either case, it is important for each person involved to track the kinds of situations (e.g., in large groups) or times of day that tend to trigger changes; using a calendar is often helpful. A few weeks of tracking can help everyone get better at anticipating problems before they arise and preparing accordingly. The key here is to keep the lines of communication open. Symptoms are not always apparent to family and friends; they may need to be told when changes are happening. Scheduling regular check-ins or updates (e.g., at mealtimes) is one way to insure that caregivers stay informed without becoming overly intrusive.
Get and Give Support
Another important part of recovery is learning that you are not alone. Over the course of a lifetime, 1 out of every 50 people experience the full onset of a psychotic episode. However, because many hide the experience from others, they are left with the impression that what happened to them is unique. By reaching out to organizations like Delaware CORE and the National Alliance on Mental Illness(www.namidelaware.org), one will find that there are many people who not only live with psychosis, but also attend school, go to work, play sports, and spend time with friends. Contrary to the media’s depiction of people with psychosis as permanent residents of institutions, most live in communities and can offer valuable advice and counsel that is based upon “lived experience.” A peer with psychosis can often understand in just a few words what takes paragraphs to explain to someone who has no experience with the illness. Peers that reach out to those “in the same boat” not only gain a valuable resource, but become a valuable resource as they share what they have learned with others.
Recommit to Personal Goals
Learning to live with a diagnosis of psychosis or early psychosis is a big adjustment. The process usually involves some loss and grieving. Sometimes it involves giving up some independence to let others help; sometimes it means putting plans on hold while one deals with the change. Grieving is a natural part of letting go of immediate goals, and it is important to make room for these emotional losses while reconsidering one’s priorities. Yet, giving up some of one’s plans is not the same as giving up entirely. As with any major shift, it is essential not to give up hope for one’s most important goals. In fact, now is the time to take stock of what is most important and recommit to it by finding people who will support one’s efforts to achieve and stay away from those who might argue that psychosis prevents the attainment of life goals. Even if progress happens at a slower pace, one must never surrender that which is most important.
It is common for people with psychosis to have times when they feel helpless and overwhelmed by symptoms. When those times make it hard for them to make decisions about treatment, it is sometimes necessary for trusted family members to step in and provide guidance on their decision making. The preferences of the person in recovery should always be the basis of any treatment decision, no matter who is making it. When it is possible to do so, people in recovery should be actively involved in making decisions about treatment. They should be encouraged to learn and ask questions about available options, and also encouraged to make those preferences known to the people who could potentially make decisions on their behalf. Similarly, people with psychosis should be made fully aware of their rights (e.g., regarding medication, access to education), as should their supporters. Family and friends can and need to support the recovery process, but it is the person in recovery who ultimately determines the goals of that process and gives it real meaning and worth.
Be Conscientious About Medication
Medicine is sometimes necessary as a defense against overwhelming symptoms, but it is not a cure all. Anti-psychotic medicines can take 4-8 weeks to be fully effective, although you may notice a gradual change during this time period. There are two main classes of medication: “Typical” antipsychotics have been around the longest, but these may cause side-effects such as involuntary movements. “Atypical” antipsychotics are more recently developed, tend to have fewer side effects, and are more frequently prescribed. It is critical to track changes in how you or your loved one responds to a drug (e.g., maybe keep a journal) and report back to the doctor or psychiatrist on any side effects. While medicine takes time to work, doctors are not mind readers and depend on patients to tell them when a drug is working or not. No medication is going to address every problem, so some symptoms are likely to persist even when taking medication. Living with some lingering symptoms of a severe mental illness is a reality for many people, but many people are able to manage their residual symptoms by exercising, getting plenty of sleep, learning to relax, engaging in pleasurable activities, or seeking accommodations at work or school. A combination of medication and therapeutic activity is the key to many peoples’ life success.